Everything You Need to Know About Leg Veins—and How to Make Them Vanish
From spider to varicose, the experts share what treatments actually work.
Every summer, as temperatures and hemlines rise, our legs face public exposure and, often, our private scrutiny. One focus of that thorough examination, particularly as women age, are leg veins. To be clear, this is not a new fixation. Women have never not had visible leg veins (in the Ebers Papyrus, an ancient Egyptian medical text dating to 1550 BC, they’re referred to as “serpentine windings”) and we’ve never not subjected ourselves to various, sometimes grisly, treatments to try to get rid of them. From surgical removal to phlebectomy (where a doctor makes an incision and then uses a hooked tool to pull out a vein, formerly without anesthesia) to iron or iodine injections, to “stripping” procedures using steel wires, vein treatments have historically come with a lot of pain and little gain.
Thanks in large part to our modern (read, increasingly sedentary) lifestyles, leg veins remain a major issue, but how we address them has, thankfully, evolved dramatically. Here’s everything you need to know about treating visible leg veins, straight from the professionals.
What Are Leg Veins?
The veins in your legs have one-way valves, working against gravity, that keep the blood flowing back toward the heart, says Christine Chung, MD, a clinical associate professor and director of the NYU Langone Vein Center in Long Island, NY. Over time, those valves can weaken or become damaged, causing blood to pool in the lower legs.
“As we age, just like we get wrinkles, the walls of our veins and the valves inside them naturally become less elastic and less efficient,” says Hugh Pabarue, MD, a physician and vein specialist at Metro Vein Centers in the Midwest. “Think of it like a door hinge that has been used thousands of times; after a while it may not close as tightly as it once did.” Those faulty hinges often manifest as two kinds of leg veins, spider and varicose, which vary in size, appearance and severity. Spider veins are small, wispy red, blue or purple veins that appear close to the skin’s surface and can look like a faint spider web (hence the name). “Often they are simply a cosmetic issue, but sometimes they can be associated with bleeding, itching or discomfort,” says Dr. Chung. Varicose veins are larger, twisted bulging veins deeper below the skin’s surface which, says Dr. Chung, are associated with leg aching, heaviness, swelling, itching, and tiredness. Their appearance, adds Dr. Pabarue, can indicate an underlying circulation problem.
Why Do We Develop Visible Leg Veins?
While men are not immune to developing leg veins, women experience them in far greater numbers. Dr. Pabarue points to a number of reasons why, including hormonal changes that can affect vein walls and valve function, while hormonal fluctuation during menstruation, pregnancy and menopause can contribute to vein enlargement. Pregnancy can be a particularly prone time, with blood volume increasing and a growing uterus placing extra pressure on leg veins, but they can, says Dr. Chung, improve postpartum. Genetics also play a big role in determining your vein risk factor.
“If your mother or father had them, you’re likely to get them too,” says Macrene Alexiades, MD, a dermatologist in New York City who treats veins. The other factors that can lead to the development of veins or venous insufficiency (when veins have trouble sending blood to the heart) are often related to our diet and lifestyle, two things that have changed significantly since the days of “serpentine windings.” Prolonged sitting or standing and a very sedentary lifestyle with little exercise can set veins on a crash course. “The muscles in the legs are less active to pump the blood from the veins back to the heart,” Dr. Chung explains. Increased weight can put extra pressure on your venous system, she adds, while tobacco can damage vein walls. A high sodium diet can also lead to fluid retention and swelling.
How Can I Minimize Leg Veins?
Luckily, there are many different ways to get rid of pesky leg veins. Whether veins pose a health or cosmetic concern, there are a number of ways, with varying degrees of pain and commitment (both financial and timewise) to address them.
Varicose veins treated with left leg phlebectomy.
The Lifestyle Shifts
To prevent veins from getting worse and new ones from forming, staying active is key. If work requires you to stand or sit for much of the day, try to find a balance. If you sit for work, elevate the legs and stand and walk every hour, says Dr. Pabarue. If you stand for work, shift positions frequently, and take walking breaks whenever you can squeeze them in. “Simple leg exercises at your desk, such as calf raises, can also keep the blood moving,” says Dr. Chung. If you’re a leg crosser, balance that too. “Make sure you’re not putting excessive pressure on one of the lateral vessels on a regular basis by crossing in the same direction all the time,” says Dr. Alexiades.
Maintaining a healthy weight, staying hydrated and eating a diet rich in fruit, vegetables and fiber all help with vein health as well. So can wearing compression socks regularly, a therapy that has been used by physicians for centuries. “Compression socks (if they are graduated and medical grade) apply the strongest pressure at the ankle, with pressure gradually decreasing up the leg,” says Anna Zahn, founder of cult body sculpting destination Ricari Studios, which makes branded compression socks. “This targeted compression optimizes blood circulation by directing flow through narrower channels toward the heart which reduces pooling in the lower limbs.” Doctors agree that wearing a pair during prolonged periods of sitting or standing, and on flights, can help manage and improve veins but they won’t cure them, notes Dr. Chung.
The In-Office Treatment
Surface lasers (which usually require several sessions and feel like a warm rubber-band snap) can do the trick for tiny spider veins, says Dr. Pabarue. Larger spider veins and smaller varicose veins (called reticular veins) often respond to sclerotherapy, whereby a chemical solution is injected causing the vein walls to stick together and eventually be absorbed by the body, says Dr. Parabue, adding that it feels like a series of small pinches. Post-treatment, patients can return to normal activities immediately.
To treat larger varicose veins, Dr. Chung suggests radiofrequency ablation (RFA) or endovenous laser therapy (EVLT) which both use ultrasound-guided heat (from radiofrequency or laser energy, respectively) and are performed under local anesthesia, addressing one vein per procedure. Patients often describe the pain more as pressure, says Dr. Chung, and they are able to return to regular activities in a few days. The most invasive option, a stab phlebectomy, has been refined to be infinitely more tolerated in the centuries since it was first introduced. The procedure still uses a small hook to remove the vein, but, says Chung, the incisions are tiny, require no stitches, and it’s performed with local anesthesia and sometimes sedation for maximum comfort. Any swelling or bruising usually resolves in a few days.
A vein patient before and after radiofrequency ablation and Varithena treatment.
The Topical Route
If the thought of vein treatments makes you squeamish, consider a camouflage approach instead. “One of the most underrated benefits of spray tanning is for veins,” says Erika Vasco, founder of The Tan Edit, adding that it works best on mild spider veins and flat surface veins. “A spray tan lays a unified veil of color over the skin that smooths and evens out the complexion.” Pain factor? Zero.
Are There Risks to Ignoring Leg Veins?
For those with mild to moderate leg veins there are no dangerous risks to ignoring them, says Chung. If patients have serious venous disease, such as venous ulcers, that’s another story, she adds, and ignoring them can lead to infections and other serious consequences. No matter what your level of leg vein symptoms, they tend to grow worse with age, says Pabarue. But if you’re diligent with compression sock use, weight management, exercise and leg elevation, you can manage vein symptoms and prevent them from getting worse—a routine that makes a visible difference.
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Meet the Experts
Hugh Pabarue, MD, DABVLM, is a double-board-certified physician and vein specialist with over 15 years of experience helping patients with their vein and vascular conditions. Widely recognized by his patients as the best vein doctor in the Metro Detroit area for personalized care, Dr. Pabarue has been a Castle Connolly Top Doctor since 2023, a peer-nominated distinction held by the top 7% of U.S. physicians.
Dr. Pabarue is certified as a Diplomate by the American Board of Venous and Lymphatic Medicine for his expertise, skill, and commitment to advancing vein treatment and has performed over 25,000 minimally invasive vein procedures. He regularly trains other physicians on the use of the latest treatments for chronic venous insufficiency, including Radiofrequency Ablations, Varithena®, and Venaseal™.
He is a respected medical leader and media contributor in the Metro Detroit community, helping to promote education and awareness of venous disorders. He has been featured in Good Housekeeping, Women’s Day, HuffPost, Men’s Journal, MSN, and on WDIV-TV Medical Minute.
Dr. Pabarue earned a Bachelor’s degree from the University of Michigan and a Master’s degree from Wright State University. He received his M.D. from the Medical College of Ohio and completed his residency at Beaumont Hospital in Royal Oak.
Chung pursued a career in surgery to be involved with the health and wellbeing of her community in a hands-on, concrete way, and vascular surgery specifically because it is a constantly evolving field that encompasses an excitingly wide breadth of procedures. Being a vascular surgeon allows Chung to take part in the long-term management of her patients with chronic vascular conditions.
Chung embraces a multidisciplinary approach in caring for her patients, collaborating with vascular lab technologists, internists, cardiologists, and other physicians in various fields to provide the most comprehensive and compassionate care.
In addition to the clinical aspects of vascular surgery, Chung has published 21 scientific publications in peer-reviewed journals and presented 18 presentations at major meetings. She has won travel scholarships and awards for her research in carotid disease and abdominal aneurysms, and regularly presents at clinical meetings and seminars.
Chung is an active member of the American College of Surgeons, Society for Vascular Surgery, the Society for Clinical Vascular Surgery, the New York Society for Vascular Surgery, the Nassau County Medical Society, and the American Medical Association.
Macrene Alexiades, MD, PhD, FAAD, FASLMS earned three degrees from Harvard
University: a BA from Harvard College, an MD from Harvard Medical School, and a PhD in Genetics from Harvard University. She was awarded a Fulbright Fellowship in molecular biology and biotechnology and has received numerous accolades, including the Harvard Medical School Dean’s Report Award, Paul Dudley White Award, Husik Prize, Fitzpatrick Clinical Innovations Award, and the Melanie Grossman Award for Leadership, Mentorship, and Public Advocacy for Women in Medical Science.
She holds the rare distinction of double board certification in dermatology in both the United States and the European Union. She currently serves as Associate Clinical Professor at Yale University School of Medicine, Adjunct Professor at the University of Athens (Sygros Hospital), and Founder and Director of the Dermatology and Laser Surgery Center in Manhattan and the Hamptons. She is also the Skin Longevity Expert for the Maybourne Hotel Group in London. Dr. Alexiades is an attending physician at Yale/New Haven Hospital and Yale/West Haven VA Hospital.
A prolific researcher, she runs both clinical trials and a basic science laboratory, alongside her active skincare line, DR. MACRENE actives. She has served on numerous academic and pharmaceutical advisory boards and contributes extensively to the scientific community as Assistant Editor for Dermatologic Surgery, Senior Associate Editor for the Journal of Drugs in Dermatology, and Associate Editor for Lasers in Surgery and Medicine. She is also a reviewer for over a dozen peer-reviewed journals.
Dr. Alexiades is the author of two textbooks: Cosmetic Dermatologic Surgery (Wolters Kluwer Lippincott) and Photodynamic Therapy (Elsevier). As a lead genetics and clinical investigator, she has recently authored four seminal publications: the newest class of hyaluronic acid fillers (Dermatologic Surgery), the first FDA-approved acne laser (Journal of the American Academy of Dermatology), the first consensus on laser best practices for urogynecologic health (Lasers in Surgery and Medicine), and innovations in radiofrequency microneedling (Facial Plastic Surgery Clinics). She also serves as a laser representative for the Laser Institute of America, the governing body
for laser standards, and is recognized as a thought leader in both aesthetic and medical dermatology.
Erika Vasco is the founder of The Tan Edit and a leading expert in the luxury sunless tanning industry. With over a decade of experience working alongside derms, plastic surgeons, and top beauty professionals, she is known for her precision technique and signature sculpted glow. As a former MUA, Vasco has redefined spray tanning as a customized, skin-conscious experience, working red carpet events and building a loyal clientele.
Anna Zahn is a multidisciplinary artist, creative entrepreneur, and founder of Ricari Studios. With foundations in classical theater and cinematic study, Anna’s work centers around storytelling, embodiment, and human connection.
Her visionary approach to wellness has established Ricari Studios as a global destination known for its signature treatment methodology, premium products, and meaningful experiences.
